Emergency Medicine: Open Access
Open Access

Abstract

Factors Associated With In-Hospital Death among Elderly Patients Sustaining a Traumatic Subdural Haemorrhage

Stephen Edward Asha, Janette Keady, Kate Anne Curtis and Saeed Kohan

Objective: To identify factors associated with in-hospital mortality amongst elderly patients with traumatic Subdural Haemorrhage [SDH], and to determine the association between mortality and exposure to anti-platelet/ anti-coagulant drugs at the time of injury.

Methods: This was a retrospective chart review of consecutive patients with SDH between August 2006 and January 2010. Clinical characteristics associated with death were determined using logistic regression. The association between death and use of anti-coagulant/anti-platelet drugs (asprin, clopidogrel, warfarin) was analysed using the Mantel-Haenszel test for trend, and further evaluated using logistic regression to control for confounding.

Results: The most common injury mechanism was a fall from standing [67%], and 66% of all patients were on antiplatelet/anticoagulant medication. Patients who died were more severely injured, had a lower GCS on arrival, larger SDH with greater mass effect, and more associated intra-cranial traumatic pathologies. Mortality increased with the bleeding tendency of the anti-platelet/anti-coagulant drug, and the severity of the injury mechanism. In contrast, age, blood pressure, pre-morbid level of function, time from injury to arrival, operative management and the presence of a focal neurological deficit had no association with death. After controlling for confounding effects, warfarin use, the number of associated intra-cranial pathologies, injury severity score and degree of midline shift were found to be independent predictors of death. Taking an anti-platelet/ anti-coagulant drug was associated with death [p<0.05], the probability of which increased with potency of the anticoagulant/ anti-platelet drug [p<0.05]. After controlling for confounders this trend persisted, although only the association with warfarin remained statistically significant.

Conclusion: In elderly patients sustaining a traumatic SDH, warfarin use, the number of associated intra-cranial pathologies, ISS and degree of midline shift were found to be predictive of death.